Healthcare Provider Details

I. General information

NPI: 1245060342
Provider Name (Legal Business Name): JOHN RYNE SASSER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 JEFFERSON ST
LAUREL MS
39440-4244
US

IV. Provider business mailing address

PO BOX 247
LAUREL MS
39441-0247
US

V. Phone/Fax

Practice location:
  • Phone: 601-426-3421
  • Fax: 601-426-2493
Mailing address:
  • Phone: 601-399-6169
  • Fax: 601-399-6281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00873
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: